Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Arthroscopy. 2010 Feb;26(2):239-48. doi: 10.1016/j.arthro.2009.06.006. Epub 2009 Dec 6.
The purpose of this study was to systematically review the evidence on the outcomes of arthroscopic repair for anterior shoulder instability in first-time dislocators when compared with patients with recurrent instability.
We designed a systematic review with a specific methodology to investigate the outcomes of surgery for those with only a first-time dislocation versus those who underwent surgery after multiple instability events. We performed a literature search from January 1966 to December 2008 using Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials. Key words included the following: first time, primary shoulder, or recurrent shoulder instability, shoulder dislocation, Bankart repair, arthroscopic Bankart repair, and labral repair. The inclusion criteria were cohort studies (Level I to II) that evaluated the outcomes of patients undergoing arthroscopic stabilization after the first dislocation or multiple recurrent episodes. Studies that lacked a comparison group or were retrospective (Level III studies or higher) were excluded.
There were 15 studies that met the inclusion criteria and were included in the final analysis: 5 in the first-time dislocation group and 10 in the recurrent instability group. Study design, patient demographics, mean number of dislocations, surgical technique, and rehabilitation protocol, as well as subjective and objective outcome measures, were recorded.
There were no differences in recurrence or complication rate among patients undergoing surgery after the primary dislocation when compared with those undergoing surgery after multiple recurrent episodes. Clinical outcome measures significantly improved within all independent studies from preoperatively to postoperatively. However, because of variation in the outcome measurement tools used, no direct comparison between the study groups could be performed. Additional randomized controlled studies are needed to compare the functional outcome, quality of life, and ability to return to preinjury activity level among patients undergoing early versus delayed repair for anterior shoulder instability.
本研究旨在系统回顾初次肩关节前向不稳定行关节镜下修复的疗效，与复发性肩关节不稳定患者进行比较。
我们设计了一项系统评价，采用特定的方法研究初次肩关节前向不稳定患者与复发性肩关节不稳定患者手术治疗的疗效。我们检索了 1966 年 1 月至 2008 年 12 月的 Medline、CINAHL（护理与联合健康文献累积索引）和 Cochrane 对照试验中心注册库。关键词包括初次、原发性或复发性肩关节不稳定、肩关节脱位、Bankart 修复、关节镜下 Bankart 修复和盂唇修复。纳入标准为评估初次肩关节前向不稳定或多次复发性肩关节前向不稳定患者行关节镜稳定术的疗效的队列研究（I 级至 II 级）。缺乏对照组或为回顾性研究（III 级或更高）的研究被排除。
符合纳入标准并最终纳入分析的研究有 15 项：初次肩关节前向不稳定患者 5 项，复发性肩关节不稳定患者 10 项。记录了研究设计、患者人口统计学特征、平均脱位次数、手术技术和康复方案以及主观和客观的疗效评估指标。
初次肩关节前向不稳定患者与复发性肩关节不稳定患者行手术治疗的复发率或并发症发生率无差异。所有独立研究的临床疗效评估指标都在术前和术后有显著改善。但是，由于所使用的疗效评估工具存在差异，因此无法对两组患者进行直接比较。需要更多的随机对照研究来比较早期与延迟修复对前向肩关节不稳定患者的功能结局、生活质量和重返伤前活动水平的影响。
